Children's Ministry: Preschool

Registration Form

If you have never registered your child(ren), please complete the following form:

	(1) Child's Name:
Select one: Boy Girl
	Birthday:
	Special Needs/Learning Challenges/Safety Concerns:
	(2) Child's Name:
Select one: Boy Girl
	Birthday:
	Special Needs/Learning Challenges/Safety Concerns:
*	Parent/Guardian Name(s):
*	Mailing Address:
*	Postal Code:
*	Home Phone:
*	Cell (for Emergency):
*	Emergency Contact:
*	Email (for notification purposes):
	Allergies or any other Medical Concerns:
	Other information that would be helpful as we care for your child(ren):
*	Enter the code displayed: